Glomerulonephritis With Masked Monotypic Immunoglobulin Deposits and Concurrent Lymphomatous Infiltration
Glomerulonephritis With Masked Monotypic Immunoglobulin Deposits and Concurrent Lymphomatous Infiltration
复制标题
DOI：
10.1053/j.ajkd.2016.05.012
复制
发表时间：
2016-10-01
影响因子：
13.2
通讯作者：
Khalighi, Mazdak A.
中科院分区：
文献类型：
--
作者：
Lloyd, Isaac E.;Khalighi, Mazdak A.
肾损伤可以是造血系统肿瘤的直接和间接机制的并发症。几乎所有的淋巴瘤和浆细胞恶液质都可以表现为肾脏受累，包括实质浸润和继发性损伤。最近，一种独特形式的肾小球肾炎与掩盖的单型免疫球蛋白沉积已被报道，这表明经常与造血肿瘤和进行性肾脏疾病的倾向。在许多情况下，由于常规免疫荧光显微镜检查缺乏免疫球蛋白染色，这些病例可能被诊断为C3占优势的肾小球肾炎。本文报告的患者在肾活检和系膜增生性肾小球肾炎中显示淋巴瘤浸润，C3染色占优势，初始免疫荧光无免疫球蛋白;然而，在石蜡包埋组织上进行额外的免疫荧光染色后，显示单型免疫球蛋白G k轻链。这位病人的情况下，突出了肾活检解释的发展状态和扩大频谱的肾脏疾病的造血系统肿瘤的设置。(C)2016年，美国国家肾脏基金会（National Kidney Foundation，Inc.）
Kidney injury can be a complication of hematopoietic neoplasia by both direct and indirect mechanisms. Virtually all lymphomas and plasma cell dyscrasias can show kidney involvement, including parenchymal infiltration and by secondary injury. Recently, a unique form of glomerulonephritis with masked monotypic immunoglobulin deposits has been reported, which shows frequent association with hematopoietic neoplasia and a propensity for progressive kidney disease. In many instances, these cases are likely diagnosed as glomerulonephritis with dominant C3 due to the absence of immunoglobulin staining by routine immunofluorescence microscopy. The patient reported here showed lymphomatous infiltration on kidney biopsy and mesangial proliferative glomerulonephritis with dominant staining for C3 without immunoglobulins on initial immunofluorescence; however, monotypic immunoglobulin G k light chain was revealed after additional immunofluorescence staining was performed on the paraffin-embedded tissue. This patient's case highlights the evolving state of kidney biopsy interpretation and the expanding spectrum of kidney disease in the setting of hematopoietic neoplasia. (C) 2016 by the National Kidney Foundation, Inc.